Diabetes leads to an imbalance between inhibitory and excitatory enteric neuropeptide ratios, which can directly cause altered gut motility. A reduction in insulin/insulin growth factor 1 (IGF-I) signaling in diabetes leads to interstitial cells of Cajal (ICC) depletion, subsequent stem cell factor depletion, and resultant smooth muscle atrophy. Here, IGF1 is linked to diabetes mellitus.